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General NPI Number Information
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NPI Number | 1487535639
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Entity Type | Individual
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Provider Name | DR. RUSSELL GARRETT CORTEZ II
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Gender | Male
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 59 W PAGES LN # 100
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City | BOUNTIFUL
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State | UT
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Zip | 84010-5988
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Country | US
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Telephone | 801-292-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 298 EDGEMONT DR
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-2636
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Country | US
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Telephone | 925-784-8289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 14235846-9926
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License Number State | UT
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